The invention relates to a computer-assisted electrocardiograph.
Thrombolytic therapy (TT), if given very early in the course of certain types of acute myocardial infarction (AMI), may be the most effective single therapy devised thus far for AMI. Controlled clinical trials have now well-established that if given early enough, TT's impact on acute mortality may approach, or even exceed, a 50% reduction. Moreover, benefits have also been documented in increased patency of infarct-related coronary arteries; improved left ventricular ejection fraction (LVEF) (i.e. cardiac function); and, as would be expected in conjunction with greater LVEF, improved long-term mortality.
If patient outcomes in the general clinical use of TT reach this level of performance, the national impact will be substantial. Even if emergency medical service (EMS) does not significantly improve its capture of the current large number of AMIs that never benefit from acute hospital care, the savings in lives would still be in the thousands. Given the more than 250,000 AMI patients hospitalized in this country every year, a drop in acute mortality from the typical 15% to 7.5% would save nearly 20,000 lives annually, not including the additional improved long-term survival also accrued by TT.
However there are reasons for limiting unrestrained use of TT. The complications can be serious, including stroke, hemorrhage, and other problems. If TT were to be used on a widespread, indiscriminate basis, the impact from these complications could be significant. In addition, a single administration of current state-of-the-art drugs for TT (e.g., tissue-type plasminogen activator: tPA) is very expensive and once given, its use leads to yet more expensive intensive care hospitalization, and either immediate or follow-up invasive tests and/or treatment, which otherwise would be less likely done. Thus, the financial impact of the widespread use of TT for acute care alone, without accounting for related additional coronary bypass surgery, may be over one billion dollars yearly. For all these reasons, in the midst of the current rapid proliferation of this new technology, there is great need for a sensitive and specific method for selecting appropriate TT candidates based on likely beneficial outcome, that can be used in the emergency clinical setting where these decisions are made.